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(PSYCHIATRIC TIMES) - Those who are experienced in the art of psychotherapy know that a good measure of creativity is needed to adapt whatever methods one uses to each patient's individual needs and abilities. However, the idea of promoting the patient's own creative potential has not been much addressed in the professional literature. Otto Rank, Ph.D., indirectly alluded to it as one of the themes in his writing, in part associated with his own background as an artist and his use of the metaphor of neurosis as a form of failure in the challenge of making one's life a work of art. Carl Jung, M.D., hinted at it in his conception of the unconscious not only as a repository of ego-dystonic, repressed ideas and feelings, but also as a source of potentially creative inspirations and images.

Perhaps the one who was most directly an advocate of the idea that therapy should promote patients' creativity was Jacob L. Moreno, M.D. (1889-1974). Moreno was the innovator who developed psychodrama and sociometry (a method of applied social psychology), was one of the pioneers of role theory, and was one of the earliest and most persistent promoters of all forms of group psychotherapy (Blatner, 1995a; Moreno, 1987). Moreno thought that a major source of psychopathology was habitual thinking--an idea that anticipated the later insights of rational emotional behavior therapy of Albert Ellis, Ph.D., and cognitive-behavioral therapy by Aaron Beck, M.D.--the latter becoming more recognized in recent years. For Moreno, however, the antidote to habitual or automatic thinking was not simply noting and correcting such patterns, but generating a more flexible capacity for creative thinking in general.

It was Moreno's unique insight that creativity is best promoted not through contemplative planning, but rather in the interactive process of improvisation, becoming physically active as a way to warm up to becoming mentally more involved (Blatner, 1996; Moreno, 1947, 1964). He called this gradual process of opening up to the delicate sources of intuition and imagination spontaneity. For Moreno, spontaneity was a key not only to creativity, but also to vitality, a source of deep enjoyment and a reminder of the most authentic aspects of the self. Spontaneity was, in some ways, related to what has also been called flow (Csikszentmihalyi, 1997). Spontaneity is also the opposite of the tendency to rely on what has already been created. Moreno recognized the need to continuously revise the subtle role definitions that pervade our lives, anticipating also those who have observed the psychosocial predicament of the individual in the "postmodern" world (Blatner, 2000).

Other therapies have also shifted in this direction, especially those utilizing the arts media. They were originally applied to help structure time and build useful capacities, and later as vehicles for producing symbolic material that could, like dreams, then be analyzed. Beginning in the 1960s or so, the "creative arts therapies" have emerged as their own fields--art, dance and movement, poetry, music, drama--all of which now give increasing emphasis to the experience of improvising itself and the benefits that accrue thereto (Blatner, 1992; Leveton, 2001).

In family therapy, a powerful strategy is that of reframing the task away from the more mechanistic issue of solving a problem, the often not-so-unconscious desire to have the therapist act as a "judge" in hearing, blaming and counter-blaming, and shift the focus toward the challenge of everyone becoming more creative, and experimenting with novel approaches. Talking about how everyone may be more creative to this end also counters their shame at being in the sick role, at having "a problem" (Blatner, 1995b).

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